Complex Regional Pain Syndrome is quite an uncommon type of chronic pain which usually affects either an arm or leg. Complex regional pain syndrome is typically found to develop following a heart attack, stroke, surgery or injury, but then this pain is out of proportion in relation to the severity of the initial injury. However, cause of complex regional pain syndrome is not yet clearly understood. Nevertheless, treatment of complex regional pain syndrome is found to be most effective in cases where it was started early. Wherever treatments were started early, improvement & even remission were possible in such cases.
Signs & Symptoms of Complex Regional Pain Syndrome
Most common signs & symptoms of complex regional pain syndrome include the following.
- Continuous throbbing or burning pain, usually in hand, arm, foot or leg
- Swelling of painful areas
- Sensitivity to cold or touch
- Changes in temperature of skin; which at times may be cold & at other times may be sweaty
- Decreased ability to move affected parts of the body
- Muscle spasms, atrophy (loss) & weakness
- Joint swelling, stiffness & damage
- Changes in nail growth & in hair
- Changes in texture of skin, which may become shiny, thin or tender in affected areas
- Changes in color of skin, which usually ranges from red or blue to white & mottled
These symptoms can often change over time & vary from one person to another. However, most commonly hypersensitivity – particularly to touch & cold, noticeable changes in temperature along with redness, swelling & pain are found to occur first. Moreover, affected limb over time can become pale & cold & undergo nail & skin changes as well along with tightening & muscle spasms. Moreover, once these changes have taken place, this condition is often irreversible. Complex regional pain syndrome may also occasionally spread from its source to other regions of the body, like the opposite limb. Pain may also be found to worsen over emotional stresses. Signs & symptoms of complex regional pain syndrome in some people are also seen to go away on its own. While in other cases signs & symptoms may even persist from months to years. Treatment is most likely to be effective when it was started early during the course of illness.
Seeking Professional Help for Complex Regional Pain Syndrome
It is time to seek professional help when people experience constant severe pain & which is making moving or touching a limb seem almost intolerable. In such a condition the person must see a doctor in order to determine the underlying cause. Moreover, it is also important to treat complex regional pain syndrome in early stages.
Causes of Complex Regional Pain Syndrome
Complex regional pain syndrome is found to occur in two types, however with different causes but similar signs & symptoms.
- Type 1 – This is also known as reflex sympathetic dystrophy syndrome. This is a type which usually occurs after an injury or illness which did not directly damage nerves within the affected limb. Almost 90 percent of the complex regional pain syndrome cases are found to be Type 1.
- Type 2 – This type was once referred to as Causalgia. This type of complex regional pain syndrome follows a distinct nerve injury.
Several cases of complex regional pain syndrome are found to occur after forceful trauma to either an arm or leg following an amputation, fracture or a crush injury. Other minor & major traumas like infections, heart attack, surgery or even sprained ankles can also lead to complex regional pain syndrome. Along with this, emotional stress may act as a precipitating factor as well for complex regional pain syndrome. However, it is still not well-understood as to why these injuries can trigger complex regional pain syndrome, but it seems this may be due to dysfunctional interaction between peripheral & central nervous systems along with inappropriate inflammatory responses.
Risks & Complications Associated with Complex Regional Pain Syndrome
In cases where complex regional pain syndrome is not diagnosed & treated early, this disease may eventually progress to more disabling signs & symptoms, including the following.
- Atrophy (Tissue Wasting) – This is usually found to happen when complex regional pain syndrome patients avoid moving an arm or leg due to pain or when these patients have trouble moving a limb due to stiffness. As a result muscles, bones & skin may begin to weaken & deteriorate.
- Contracture (Muscle Tightening) – Some complex regional pain syndrome patients may also experience tightening of muscles. This can eventually lead to a condition in which the patient’s fingers & hand or toes & foot contract into a fixed position.
Initial Appointment for Complex Regional Pain Syndrome
- How Patients Can Prepare for Initial Appointment
In preparation for initial appointment, patients should write down symptoms they are experiencing, including location & severity of pain, sensitivity or stiffness. It is also sensible to write down questions they would like to ask the specialist doctor (rheumatologist) since they might not be able to remember everything during the initial appointment. Some examples of questions which patients can ask doctors are listed below.
- What likely causes are there for the symptoms I am experiencing?
- What type of tests, if any, will I need to undergo?
- Is my condition likely to be temporary or chronic?
- What treatment options do I have? Which treatment option would you recommend?
- What other alternatives do I have for the primary approach which you are suggesting?
- I am also having some other health conditions. How best can I manage them together?
- Do we have a generic alternative to the medicine you would like to prescribe for me?
- Can you provide me any brochures or some printed material giving me information on this subject?
- Which websites do you recommend I visit for more information?
In addition to these questions which patients prepare to ask doctors, they should however not hesitate to ask any additional questions which come to their mind during the initial appointment.
- Questions Which Doctors Usually Ask Patients
Specialist doctors are most likely to ask a number of questions to complex regional pain syndrome patients. Being prepared to answer them may reserve time for patients to go over other points they want to spend more time upon. Since time with specialist doctors is limited, it would sensible to stay prepared. Doctors would usually ask the following questions to complex regional pain syndrome patients during the initial appointment.
- Did you have any recent injury, illness or accident, like infection, heart attack or trauma to limbs?
- Did you undergo surgery lately?
- When was it that you first experienced burning or pain?
- How long has it been that you are experiencing these symptoms?
- Is your experience of pain occasional or continuous?
- Is there anything, if at all, which seems to improve or worsen your symptoms?
- Did you experience similar symptoms in past following injuries?
Tests & Diagnosis for Complex Regional Pain Syndrome
Diagnosis of complex regional pain syndrome is normally based upon a physical examination & medical history of the patient. However, there is no single test which can definitely diagnose complex regional pain syndrome. Nevertheless, following tests & procedures can provide important clues for diagnosis.
- Bone Scan – This procedure is meant to help detect changes in bone. For this purpose a radioactive substance is injected into one of the patient’s vein. This will eventually permit viewing of the patient’s bones with help of a special camera.
- Sympathetic Nervous System Tests – These tests are designed to look for any disturbances within the patient’s sympathetic nervous system. Like for example, thermography measures blood flow & skin temperature of the patient’s affected & unaffected limbs. Some other tests can measure amount of sweat on both the limbs. Dissimilar results would generally indicate presence of complex regional pain syndrome.
- X-Rays – Loss of minerals from bones can show up on x-rays during the later stages of complex regional pain syndrome.
- MRI – Magnetic Resonance Imaging – Images captured through magnetic resonance imaging (MRI) will be able to show a number of changes in tissue of complex regional pain syndrome patients.
Treatments & Drugs for Complex Regional Pain Syndrome
Improvement or even remission of complex regional pain syndrome is possible when treatment starts within a few months of the time when patients experience first symptoms. Quite often a combination of various therapies is required for treatment. Most often, doctors would tailor a treatment plan based upon specifics of each case. Some of the most common treatment options include the following.
- Medications – Doctors usually use various medications to treat complex regional pain syndrome signs & symptoms.
- Pain Relievers – These generally consist of over-the-counter (OTC) pain relievers like aspirin, naproxen (Aleve) & ibuprofen (Motrin IB, Advil) & which may ease inflammation & pain. Doctors may also prescribe stronger pain relievers in case OTC medications have not proved to be useful. Opioid medications can also be an option & when taken in appropriate doses, they can provide acceptable control of pain.
- Anticonvulsants & Antidepressants – Sometimes anticonvulsants like gabapentin (Neurontin, Gralise) & antidepressants like amitriptyline are used in treatment for pain which generally originates from damaged nerves (neuropathic pain).
- Corticosteroids – Steroid medications like prednisone can often reduce inflammation & subsequently improve mobility in the affected limb of complex regional pain syndrome patients.
- Bone Loss Medications – Doctors often suggest medications to stall or prevent bone loss in complex regional pain syndrome patients. These include calcitonin (Miacalcin) & alendronate (Fosamax).
- Sympathetic Nerve-Blocking Medications – Injection containing anesthetic to block pain fibers in affected nerves can also relieve pain in some cases.
- Intravenous Ketamine – Studies have shown that low doses of intravenous ketamine, which is a strong anesthetic, can substantially alleviate pain. Although, despite relief in pain, this showed no improvement in function.
- Therapies for Complex Regional Pain Syndrome
- Applying Heat & Cold – Application of cold can relieve sweating & swelling. However, when the affected area is cold, application of heat will offer relief.
- Topical Analgesics – There are various types of topical treatments which are available & may reduce hypersensitivity in complex regional pain syndrome patients. Some good examples include lidocaine patches (Lidoderm) or caosaicin cream (Zostrix, Capsagel, Capsin).
- Physical Therapy – Gentle & guided exercise of affected limbs can help decrease pain while improving strength & range of motion. Early diagnosis of disease will however make exercise more effective.
- TENS – Transcutaneous Electrical Nerve Stimulation – Quite often, chronic pain is eased with application of electrical impulses to nerve endings.
- Biofeedback – Learning biofeedback techniques can be very helpful for complex regional pain syndrome patients. Biofeedback will teach the patient to be more aware of the body so that they can relax & relieve pain.
- Spinal Cord Stimulation – During this procedure, doctors would insert tiny electrodes along the patient’s spinal cord. Subsequently a small electrical current is delivered to the spinal cord & which results in relief from pain.
Recurrence of complex regional pain syndrome is also found to occur. Sometimes it is due to triggers like intense emotional stressors or exposure to cold. Recurrences may however be treated with smaller doses of antidepressants or other medications.
Coping & Support for Complex Regional Pain Syndrome Patients
Living with a painfully chronic condition can be a challenging task, especially in cases of complex regional pain syndrome, when friends & family fail to understand or believe that the patient could be feeling as much pain as they describe. Therefore, it would be sensible of patients to share information from reliable sources regarding complex regional pain syndrome with people close to them so that they can understand what the patient is experiencing. Here are a few suggestions for taking care of mental & physical health of complex regional pain syndrome patients.
- Maintaining normal level of daily activities as best as possible.
- Patients must pace themselves & make sure that they get enough rest.
- Complex regional pain syndrome patients should stay connected with family & friends.
- Patients should continue to pursue hobbies which they enjoy & are able to do so.
When complex regional pain syndrome makes it difficult for the patient to do things which they enjoy, they must talk to doctors about ways which can help them get around obstacles. Complex regional pain syndrome patients should bear in mind that physical health can directly affect mental health & vice versa. Anger, denial & frustration are most common with all chronic illnesses. Moreover, these patients may at times require more tools to deal with emotions. Therefore a behavioral psychologist, a therapist or other such professionals can be able to help them put things in perspective. These professionals can also teach patients coping skills like meditation or relaxation techniques. Quite often joining a support group, where patients can share feelings & experiences with other people in similar conditions, is a practical approach. For this purpose, complex regional pain syndrome patients can also ask doctors about availability of such support groups within the community.
Preventive Measures for Complex Regional Pain Syndrome
Following measures will help people reduce risk of developing complex regional pain syndrome.
- Taking Vitamin C after Wrist Fracture – Studies have revealed that people who took a minimum dose of 500 mg of vitamin C every day after wrist fracture lowers risk of developing complex regional pain syndrome when compared with people who did not take vitamin C.
- Early Mobilization Following Stroke – Research suggests that persons who are out of bed & walk around sooner following a stroke (early mobilization) generally lower their risk of developing complex regional pain syndrome.
Variety of Low Cost Orthopedic Treatments in India
Over the years, Indian healthcare sector has gained immense strength so as to qualify as a leading global medical tourism destination providing a variety of affordable medical procedures including treatment & surgery for bone & joint problems. There is a vast pool of expert doctors & surgeons, who have now settled in India & have in fact made this possible. Many of these doctors are globally reputed & have initially trained & experienced for decades in advanced western countries like Canada, UK & United States before returning to their homeland. Their hard work accompanied by successful outcomes they have continuously delivered has helped India attain this status. Along with this India has also developed an extensive network of nationally & internationally accredited hospital facilities which are committed to adhere to standardized norms. Sensing opportunity, global healthcare giants like Wockhardt, Apollo, Fortis Hospitals, & Max Healthcare have also set up numerous branches all around the country. Most of these healthcare institutions are equipped with latest technology of diagnostic & surgical tools required to deliver successful results. Moreover, highly skilled nurses & professional staff who manage these institutions speak English, which is another assuring factor for the international patient who can be assured to recover in a comfortable & familiar environment following a successful surgical intervention.
Treatments for Complex Regional Pain Syndrome with Orthopaedic Surgery India
Orthopaedic Surgery India has proudly gained global recognition under the Travcure Medical Tourism flagship banner. We are a specialty healthcare tourism company providing a wide spectrum of affordable orthopedic treatments to people from all around the world. We are associated with numerous multispecialty healthcare institutions across the length & breadth of the country & very well placed to pass on the benefits to our patients. Wide range of seamless services offered by Orthopaedic Surgery India in fact begins with the first telephonic conversation with the patient when he/she relates the medical problem. Swinging into action, our experts will subsequently identify the best doctor & treatment facility in cooperation with the patient. Other essential services which we offer to patients include assisting them in obtaining medical visas, receiving them at airports when they arrive for treatments, arranging convenient options for local travel, choice of accommodation options including budget or luxury hotels or serviced apartments near the treatment facility, scheduling appointments with doctors for treatments without any waiting periods, follow-up evaluation checks for speedy recovery & an affectionate farewell when the patient is heading back home after successful treatments.